Successful term pregnancy after renal transplant in end-stage renal disease with complement factor H-related mutation: A case report

Table 1 Clinical timeline and management course of the patient from renal transplantation to postpartum follow-up

Timepoint	Event	Details
Month 0	Renal transplantation	Underwent live-donor renal transplantation with her mother as the donor. Induction with anti-thymocyte globulin (50 mg) was administered; maintenance included tacrolimus, MMF, and prednisolone. Postoperative recovery was uneventful
Month 1	Graft stabilization	Serum creatinine remained stable. Doppler ultrasonography confirmed adequate perfusion. Tacrolimus trough levels rose from 8.95 ng/mL to 9.43 ng/mL (dose adjusted from 2.5 mg/day to 3.5 mg/day)
Month 4	Polycythemia	Developed secondary polycythemia, managed with therapeutic phlebotomy and telmisartan
Months 5-12	Maintenance phase	Graft function remained stable with no recurrence of TMA. Maintained on tacrolimus 1.5 mg twice daily (trough: 6.2-7.6 ng/mL)
Month 12	Pregnancy planning	Patient expressed desire for conception. MMF was replaced by azathioprine after TPMT genotyping confirmed high enzyme activity. Telmisartan was switched to nifedipine and labetalol. CMV and toxoplasma serologies were negative
Month 15	Conception	Spontaneous conception occurred within three months of immunosuppressive modification
2nd Trimester	Antenatal hypertension	Developed transient gestational hypertension, controlled with nifedipine, labetalol, and amlodipine. Tacrolimus levels ranged from 4.3 ng/mL to 7.0 ng/mL. No recurrence of TMA was observed
3rd trimester	Stable course	Laboratory parameters remained within normal limits. CMV PCR and toxoplasma results were negative. Experienced a mild self-limited upper respiratory tract infection
Week 36	Delivery	Delivered a healthy female infant (3.0 kg) via elective lower segment caesarean section
Postpartum	Recovery and follow-up	Experienced transient postpartum hypertension, managed conservatively. At six weeks and three months postpartum, both mother and infant were clinically stable; no graft dysfunction or relapse was noted

CMV: Cytomegalovirus; MMF: Mycophenolate mofetil; TPMT: Thiopurine methyltransferase; TMA: Thrombotic microangiopathy; PCR: Polymerase chain reaction.